OBJECTIVES: To estimate the incidence of neonatal tetanus (NT) and to study the factors associated with NT mortality in Dadu district, Pakistan. METHODS: This study is a retrospective analysis of surveillance data from 1993-2003. NT cases were identified from the district surveillance database and hospital records reviews. Cases were ascertained using the NT standard case definition. Clinical records of all neonates (n = 416) admitted with the diagnosis of NT from 1993 through 2003 were reviewed for clinical presentation, progression and outcome. Rates, means and frequencies were calculated. Odds ratio was calculated to determine the association between potential risk factors and NT mortality. Logistic regression models were used to compute odds ratios and their associated 95% Confidence Intervals. RESULTS: Out of a total of 416 NT cases, 408 met the case definition. The overall case fatality rate (CFR) for NT was 30.1% (95% Confidence Interval (CI):25.6-34.6); CFR fell from 42% in 1993 to 29% in 2003 (p = 0.377). NT incidence decreased from 0.90/1000 live births (LB) in 1994 to 0.18/1000 LB in 2003. Multivariable analysis showed that age at admission of 8 days or less with {Odds Ratio (OR) 9.41, CI: 2.67-33.14} or without (OR 2.62, CI: 1.52-4.50) low neonatal weight was the strongest predictor of mortality. CONCLUSIONS: The rate of decline of neonatal tetanus incidence and case fatality was consistent with the impact of routine and supplementary immunization activities. In addition to strengthening maternal tetanus toxoid immunization coverage and hygienic delivery practices, health education focusing on increasing awareness of NT could help reduce NT mortality.
OBJECTIVES: To estimate the incidence of neonatal tetanus (NT) and to study the factors associated with NT mortality in Dadu district, Pakistan. METHODS: This study is a retrospective analysis of surveillance data from 1993-2003. NT cases were identified from the district surveillance database and hospital records reviews. Cases were ascertained using the NT standard case definition. Clinical records of all neonates (n = 416) admitted with the diagnosis of NT from 1993 through 2003 were reviewed for clinical presentation, progression and outcome. Rates, means and frequencies were calculated. Odds ratio was calculated to determine the association between potential risk factors and NT mortality. Logistic regression models were used to compute odds ratios and their associated 95% Confidence Intervals. RESULTS: Out of a total of 416 NT cases, 408 met the case definition. The overall case fatality rate (CFR) for NT was 30.1% (95% Confidence Interval (CI):25.6-34.6); CFR fell from 42% in 1993 to 29% in 2003 (p = 0.377). NT incidence decreased from 0.90/1000 live births (LB) in 1994 to 0.18/1000 LB in 2003. Multivariable analysis showed that age at admission of 8 days or less with {Odds Ratio (OR) 9.41, CI: 2.67-33.14} or without (OR 2.62, CI: 1.52-4.50) low neonatal weight was the strongest predictor of mortality. CONCLUSIONS: The rate of decline of neonatal tetanus incidence and case fatality was consistent with the impact of routine and supplementary immunization activities. In addition to strengthening maternal tetanus toxoid immunization coverage and hygienic delivery practices, health education focusing on increasing awareness of NT could help reduce NT mortality.
Authors: Phung Khanh Lam; Huynh T Trieu; Inke Nadia D Lubis; Huynh T Loan; Tran Thi Diem Thuy; Bridget Wills; Christopher M Parry; Nicholas P J Day; Phan T Qui; Lam Minh Yen; C Louise Thwaites Journal: Int J Infect Dis Date: 2014-12-12 Impact factor: 3.623